652.8 affecting fetus or newborn 763.4 anteversion, cervix or uterus 654.4 atony, uterus 661.2 bicornis or bicornuate uterus 654.0 breech presentation (buttocks) (complete) (frank) 652.2 brow presentation 652.4 cephalopelvic disproportion (normally formed [icd9data.com]

Most women present with abdominal pain, postpartum hemorrhage, a visible vaginal mass or palpable mass at bimanual exam. [emergencymedicinecases.com]

Mothers present with features of anemia (e.g., lightheadedness, pallor) or hypovolemic shock (e.g., hypotension, tachycardia ). [amboss.com]

Ultrasound is not helpful in endometritis. [ 17 ] Management If sepsis is suspected in the community, urgent referral to hospital is indicated where 'red flag' signs and symptoms are present. [patient.info]

inconsistency present, unknown or not applicable), directness (direct, indirect), precision (precise, imprecise), and reporting bias (present, undetected). [effectivehealthcare.ahrq.gov]

• Fever

  Doctors must recognize the risk factors for endomyometritis injuries, including fever, high white blood count, and uterine tenderness. Proper treatment usually includes antibiotics, and D&C if retained products of conception are discovered. [birthinjuryjustice.org]

  Assessment History Symptoms vary but may include: Fever. Abdominal pain. Offensive smelling lochia. Abnormal vaginal bleeding - postpartum haemorrhage. Abnormal vaginal discharge. Dyspareunia. Dysuria. General malaise. [patient.info]

  On her fourth inpatient day in the provincial hospital, she suddenly had a continuous high-grade fever (39°C) associated with myalgia and arthralgia. [f1000research.com]

  […] placental fragments or membranes that remain within the uterus due to abnormal placental separation in the postpartum period, suggested by: Abnormal uterine bleeding or postpartum hemorrhage at the time of attempted manual separation of the placenta Fever [amboss.com]

  Cases of uterine inversion, University of Michigan, 1970–1980 Patient Age Para Estimated blood loss (mL) Shock Postpartum complications Postpartum stay (days) 1 23 0 2500 ++ Fever 4 2 24 1 2000 None 5 3 26 1 2000 ++ None 4 4 19 0 1900 Fever 3 5 30 0 1500 [glowm.com]

• Weakness

  […] loss greater than or equal to 500 ml after vaginal birth or greater than or equal to 1000 ml after cesarean delivery, but more commonly defined and diagnosed clinically as excessive bleeding that makes the patient symptomatic: pallor, lightheadedness, weakness [openanesthesia.org]

  You may have PPH if you have heavy bleeding from the vagina that doesn’t slow or stop, blurred vision, chills, or if you feel weak or feel faint. You’re more likely to have PPH if you’ve had it in the past. [marchofdimes.org]

  B-12 A lot of the focus tends to be on iron, but B-12 is a great vitamin supplement that helps with weakness, fatigue and anemia. Some great sources of B-12 are fish and shellfish, meats, poultry and eggs. 5. [modernalternativepregnancy.com]

  The woman has symptoms of significant blood loss, such as low blood pressure, a rapid heart rate, dizziness, light-headedness, fatigue, and weakness. Excessive blood loss usually occurs soon after delivery but may occur as late as 1 month afterward. [msdmanuals.com]

• Chills

  You may have PPH if you have heavy bleeding from the vagina that doesn’t slow or stop, blurred vision, chills, or if you feel weak or feel faint. You’re more likely to have PPH if you’ve had it in the past. [marchofdimes.org]

  […] previously described management has been conducted (tutorial author) It is very expensive compared with Methergine and Pitocin (tutorial author) The side effects are very uncomfortable and include nausea, vomiting, diarrhea, flushing or hot flashes and chills [library.med.utah.edu]

  Side effects: diarrhea, fever, chills, nausea, emesis, headache, flushing. Contraindications: asthma, active cardiac, hepatic or renal disease. Misoprostol (Cytotec) Dose: 400-1000 micrograms. [clinicaladvisor.com]

• Internal Bleeding

  Bleeding of more than 500 mL in a normal vaginal delivery and more than 1000 mL in a cesarean birth qualifies for a postpartum hemorrhage. Tense and rigid uterus. This may also indicate internal bleeding and possible external bleeding. [nurseslabs.com]

  Your blood pressure, pulse, urine output (through a catheter) and your vaginal bleeding will be closely monitored. If you had an operation a drain may have been inserted near your wound to check for any internal bleeding. [brochures.mater.org.au]

  In the case of patients who were operated, the doctor will check for any internal bleeding. You will be looked after in the intensive ward and later moved to the postnatal unit after the doctor is assured of no further risk ( 11 ). [momjunction.com]

• Intravenous Administration

  If that doesn't work then intravenous administration of Misoprostol, Oxytocin or Pitocin is made to stop the blood loss. If the bleeding still goes on, then the mother is given fluids and blood through IV. [defranciscolaw.com]

• Dyspnea

  Transfusion-related acute lung injury (TRALI): It is a life-threatening complication characterized by severe dyspnea, hypoxia and noncardiogenic pulmonary edema. Onset is usually 6 hours after transfusion but can occur up to 72 hours later. [clinicaladvisor.com]

• Vomiting

  Diarrhoea and/or vomiting. Uterine or renal angle pain and tenderness. Woman is generally unwell or seems unduly anxious/distressed. Speculum examination will allow visualisation of the cervix and lower genital tract to exclude lacerations. [patient.info]

  However, these ergot alkaloid agents raise blood pressure, hence they are contraindicated in women with hypertension. [7] Other adverse effects include nausea and vomiting. [wikihow.com]

  […] unnecessary in the vast majority of cases in which the previously described management has been conducted (tutorial author) It is very expensive compared with Methergine and Pitocin (tutorial author) The side effects are very uncomfortable and include nausea, vomiting [library.med.utah.edu]

  Misoprostol (Cytotec, PGE 1 ) 800-1,000 mcg rectally Can cause nausea and vomiting. Abbreviations: IV, intravenously; IM, intramuscularly; PG, prostaglandin. [womenshealthsection.com]

  Because ergot alkaloid agents raise blood pressure, they are contraindicated in women with preclampsia or hypertension. 33 Other adverse effects include nausea and vomiting. 33 Prostaglandins enhance uterine contractility and cause vasoconstriction. 34 [aafp.org]

• Abdominal Pain

  Most women present with abdominal pain, postpartum hemorrhage, a visible vaginal mass or palpable mass at bimanual exam. [emergencymedicinecases.com]

  Abdominal or chest pain. Diarrhoea and/or vomiting. Uterine or renal angle pain and tenderness. Woman is generally unwell or seems unduly anxious/distressed. [patient.info]

  Haematometra might present with amenorrhoea 33 and pyometria coupled with abdominal pain and fever, weeks or months postpartum. 34 The occurrence of uterine cavity synechiae causing uterine outflow obstruction has also been reported after compression [hkmj.org]

• Hypotension

  Hypotension was managed with crystalloid and hydroxy ethyl starch. Three units of packed red blood cells and 1gm of tranexamic acid were given. A total of 4 litres of fluids including blood products was transfused. [apicareonline.com]

  The OR may be needed to definitively identify source of bleeding. history physical exam History Interview the patient for signs and symptoms of hypotension. [sharinginhealth.ca]

  […] but more commonly defined and diagnosed clinically as excessive bleeding that makes the patient symptomatic: pallor, lightheadedness, weakness, palpitations, diaphoresis, restlessness, confusion, air hunger, syncope, and/or results in hypovolemia – hypotension [openanesthesia.org]

  If bleeding continues, tachycardia and hypotension worsen. As a protective effect to maintain cardiac output, peripheral vasoconstriction occurs, leading to decreased tissue perfusion. [clinicaladvisor.com]

  IM: 10 units Continuous Avoid undiluted rapid IV infusion, which causes hypotension. [womenshealthsection.com]

• Hypertension

  Other options include (most contraindicated with hypertension or asthma): prostaglandin E1 derivative (misoprostol) PO, sublingual, or PR (may cause significant GI upset) ergometrine (caution with hypertension and some HIV medications) methylergonovine [sharinginhealth.ca]

  Syntometrine® (oxytocin plus ergometrine) may also be used in the absence of hypertension. [patient.info]

  There is no clear evidence suggesting superior efficacy of ergot derivatives over oxytocin, although ergot preparations appear to be associated with a higher incidence of hypertension and should not be used in hypertensive patients. [glowm.com]

  see Hypertension, complicating pregnancy hypertonic uterine dysfunction 661.4 hypotonic uterine dysfunction 661.2 impacted shoulders 660.4 incarceration, uterus 654.3 incomplete dilation (cervix) 661.0 incoordinate uterus 661.4 indication NEC 659.9 [icd9data.com]

• Flushing

  Flushing the drainage port with sterile saline will allow clots to be removed and prevent occlusion of the tube with clotted blood. Do not leave in place for more than 24 hours. [clinicaladvisor.com]

  […] majority of cases in which the previously described management has been conducted (tutorial author) It is very expensive compared with Methergine and Pitocin (tutorial author) The side effects are very uncomfortable and include nausea, vomiting, diarrhea, flushing [library.med.utah.edu]

  Side effects of diarrhea, hypertension, vomiting, fever, flushing, and tachycardia are common. 19 Patients with significant cardiac or pulmonary disease will be at high risk should systemic side effects develop; thus, prostaglandins should be used with [glowm.com]

  Side effects include nausea, vomiting, diarrhea, hypertension, headache, flushing, and pyrexia. 34 Misoprostol is another prostaglandin that increases uterine tone and decreases postpartum bleeding. 36 Misoprostol is effective in the treatment of postpartum [aafp.org]

• Fear

  Death during childbirth has been feared throughout time, and dramatized in countless movies and books. [naturalbirthandbabycare.com]

  Answer your questions with rational, fact-based information instead of fear. [modernalternativepregnancy.com]

  Furthermore, PPH may have a long‐term psychological impact on women's health in the form of negative memories of childbirth and postpartum period with the main fear being of death (Sentilhes 2011a). [cochranelibrary.com]

• Hunger

  […] than or equal to 1000 ml after cesarean delivery, but more commonly defined and diagnosed clinically as excessive bleeding that makes the patient symptomatic: pallor, lightheadedness, weakness, palpitations, diaphoresis, restlessness, confusion, air hunger [openanesthesia.org]

  In excessive blood loss, manifestations of shock appear as hypotension, rapid pulse, cold sweaty skin, pallor, restlessness, air hunger and syncope. [gfmer.ch]

  Compensated 1000-1500 mL (15-25%) Slight fall (80-100 mm Hg) Weakness, tachycardia, sweating Mild 1500-2000 mL (25-35%) Moderate fall (70-80 mm Hg) Restlessness, pallor, oliguria Moderate 2000-3000 mL (35-50%) Marked fall (50-70 mm Hg) Collapse, air hunger [emedicine.medscape.com]

• Anger

  The findings are supported by the Anger 2016 step‐wedge cluster‐randomised trial. [cochranelibrary.com]

• Stroke

  […] involving the postpartum care of the mother, including failure to recognize and treat: Anesthesia-related illness Infection/sepsis Life-threatening bowel obstructions after C-section Hemorrhage (uncontrolled bleeding) Pulmonary embolism (that can cause a stroke [birthinjuryjustice.org]

• Vaginal Bleeding

  In an attempt to avoid laparotomy, we placed a thrombin-soaked uterine pack over the bleeding site. There was minimal vaginal bleeding during the following 8 hours, so the pack was removed. [ncbi.nlm.nih.gov]

  […] from the myometrial vessels Epidemiology : responsible for ∼ 80% of PPH cases Risk factors : overdistention of the uterus Clinical findings Abnormal vaginal bleeding Soft, enlarged (increased fundal height ), boggy ascending uterus Diagnosis : clinical [amboss.com]

  Premature placental separation; Placental separation; Placental abruption; Vaginal bleeding - abruption; Pregnancy - abruption 1. The uterus is exposed through the abdominal wall, and an incision is made in the uterine covering. 2. [mountsinai.org]

  Bleeding of more than 500 mL in a normal vaginal delivery and more than 1000 mL in a cesarean birth qualifies for a postpartum hemorrhage. Tense and rigid uterus. This may also indicate internal bleeding and possible external bleeding. [nurseslabs.com]

  What is severe postpartum bleeding? Severe postpartum bleeding is the loss of more than 1 pint (500 milliliters) of blood soon after a baby is born vaginally, or 2 pints (1000 milliliters) after a C-section. [summitmedicalgroup.com]

• Uterine Hemorrhage

  Respiratory Aspiration Postpartum Hemorrhage Pathologic Processes Respiration Disorders Respiratory Tract Diseases Obstetric Labor Complications Pregnancy Complications Puerperal Disorders Uterine Hemorrhage [clinicaltrials.gov]

  The obstetrician should also be aware of the potential of uterine rupture to cause massive hemorrhage. Although uterine rupture occurs most often with a prior uterine scar, it can occur spontaneously. [glowm.com]

  Uterine artery ligation in the control of postcesarean hemorrhage. J Reprod Med. 1995 Mar. 40(3):189-93. [Medline]. AbdRabbo SA. [emedicine.medscape.com]

Liver and renal function tests as well as coagulation workup revealed no abnormalities. In the delivery room, the patient was administered 2 units of packed platelet concentrate in around 30 minutes before giving birth. [f1000research.com]

• Chlamydia

  High vaginal swab; also gonorrhoea/chlamydia. Ultrasound - may be used if RPOC are suspected, although there may be difficulty distinguishing between clot and products. RPOC are unlikely if a normal endometrial stripe is seen. [patient.info]

• Polyps

  SECONDARY POSTPARTUM HAEMORRHAGE Aetiology Retained parts: of the placenta, membranes, blood clot or formation of a placental polyp. [gfmer.ch]

  […] prolapse of umbilical cord 663.0 oversize fetus 653.5 pathological retraction ring, uterus 661.4 pelvic penetration, pregnant uterus by instrument 665.1 perforation - see Delivery, complicated, laceration persistent placenta, placental polyhydramnios 657 polyp [icd9data.com]

While these results are promising, Shin stressed the necessity to explore the impact of the treatment on future fertility. [sciencedaily.com]

Once we've approved your claim, you'll get the private treatment you need. 3 And we’ll pay for treatment After you've been treated, send us your invoices. [aviva.co.uk]

If you have atony of the uterus, you’ll need immediate treatment to help stop the bleeding and to replace the lost blood. Postpartum hemorrhage can be very serious. However, early detection and treatment can lead to a full recovery. [healthline.com]

One must quickly work through the differential causes and rapidly initiate treatment. [clinicaladvisor.com]

Many obstetricians choose rectal misoprostol alone or in combination with oxytocin as the preferred treatment of PPH. [mdedge.com]

Standard of Care and Prognosis Close monitoring is the best route for PPH. The mother's condition, skin color, blood pressure, blood loss, uterine size and tone are closely assessed. [defranciscolaw.com]

Prognosis 90% of cases of postpartum endometritis treated with antibiotics improve within 48-72 hours. [ 16 ] If this is not the case, the patient should be re-evaluated. [patient.info]

Prognozis Prognosis of PPH depends mostly on the cause, but the underestimation of blood loss, delaying diagnosis and treatment may lead to a life threatening situation. References 1. American College of Obstetricians and Gynecologists. [folk.uio.no]

Prognosis and outcome A. Maternal/fetal outcomes PPH is still a leading cause of maternal morbidity in the United States. Institution of protocols for the treatment of postpartum hemorrhage can reduce mortality associated with hemorrhage. B. [clinicaladvisor.com]

[…] placental delivery Blood loss > 1000 mL for cesarean section occurring at any time, either before, during, or after placental delivery Primary PPH (most common): blood loss within 24 hours Secondary PPH: blood loss from 24 hours to 12 weeks postpartum Etiology [amboss.com]

Diagnostic maneuver Etiology Therapeutic Maneuver Uterine palpation Uterine atony Blood for typing and cross-maching Establishment I/V infusion system (1 or 2) Uterotonic agents Indwelling urinary catheter Oxygen through mask Massage of the uterus Bimanual [folk.uio.no]

The differential diagnosis for the etiologies of early PPH include: Uterine atony Lacerations Retained placenta Uterine inversion Uterine rupture Examination is key to revealing the etiology. Bimanual pelvic exam will identify uterine atony. [clinicaladvisor.com]

Treatment varies depending on the etiology, and clinicians need to know the optimal assessment methods to determine the cause. [effectivehealthcare.ahrq.gov]

Severe secondary postpartum hemorrhage 3 weeks after cesarean section: alternative etiologies of uterine scar non-union. J Obstet Gynaecol Res 2007; 33:360-62. [ Links ] 35. Nanda S, Singhal S, Sharma D, Sood M, Singhal SK. [scielo.org.mx]

[…] issue, T hrombin References: [1] [2] Uterine atony Definition : failure of the uterus to effectively contract and retract after complete or incomplete delivery of the placenta, which can lead to severe postpartum bleeding from the myometrial vessels Epidemiology [amboss.com]

Epidemiology Obstetric haemorrhage is no longer a major cause of maternal death in the UK. [patient.info]

Epidemiology of postpartum haemorrhage: a systematic review. Best Pract Res Clin Obstet Gynaecol 2008 Dec;22(6):999-1012. PMID: 18819848. Calvert C, Thomas SL, Ronsmans C, et al. [effectivehealthcare.ahrq.gov]

[…] oxytocin as part of the active management found similar benefits with giving it before or after the expulsion of the placenta. [42] There is no good quality evidence on how best to treat a secondary PPH (PPH occurring 24 hrs or more after the birth). [43] Epidemiology [en.wikipedia.org]

Epidemiologic profile of maternal deaths in two referral hospitals in Cameroon. Open J Obstet Gynecol. 2016;06(06):365–72. View Article Google Scholar World Health Organization. [bmcpregnancychildbirth.biomedcentral.com]

Pathophysiology There are different main causes of postpartum hemorrhage, and they cause bleeding in different ways. In uterine atony, the uterus stops contracting, which leads to bleeding because the placental sites have closed. [nurseslabs.com]

If it does, there is probably other pathophysiology occuring. At this point an obstetric consultant should be contacted in the event that high acuity medical or surgical procedures are needed. [library.med.utah.edu]

Pathophysiology Over the course of a pregnancy, maternal blood volume increases by approximately 50% (from 4 L to 6 L). [emedicine.medscape.com]

Buzolits, Anna; Geshwender, Sarah; Petri, Taylor; Toor, Jordan Abstract: The project focused on creating a method of prevention for postpartum hemorrhage (PPH) in low-income hospitals. [deepblue.lib.umich.edu]

Again prevention is critical regarding PPH. [sharinginhealth.ca]

In settings in which reliable refrigeration is not available, misoprostol, a medication that is heat-stable, is often used to prevent and treat PPH. [mdedge.com]

Other risk factors include obesity, fever during pregnancy, bleeding before delivery, and heart disease. [7] Prevention [ edit ] Oxytocin is typically used right after the delivery of the baby to prevent PPH. [2] Misoprostol may be used in areas where [en.wikipedia.org]

Atony of the uterus can’t always be prevented. It’s important that your doctor knows how to manage this condition in all stages of labor. [healthline.com]